Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TCD > Case 02 - Asthma > Flashcards

Case 02 - Asthma Flashcards

1
Q

Percentage of the population affected asthma

A

5-8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Asthma is characterised by…

A

…recurrent episodes of SOB, cough and wheeze caused by reversible airways obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Another word for shortness of breath

A

Dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What 3 factors contribute to airway narrowing in asthma and what is their cause?

A
  • Bronchial muscle contraction (triggered by a variety of stimuli)
  • Mucosal swelling/inflammation (mast cell and basophil degranulation –> release of inflammatory mediators)
  • Increased mucus production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms

A

Intermittent dyspnoea, wheeze, cough, chest tightness, sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which symptom is often nocturnal?

A

Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Precipitants (triggers/exacerbators)

A

Cold air, exercise, emotion, allergens, infection, smoking (inc. passive), NSAIDs, beta-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is meant by diurnal variation

A

Symptoms and/or peak flow may vary over the day and are typically worse in the morning (known as morning ‘dips’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What 3 questions can be asked to asses symptomatic control?

A

(1) In the last week/month, have you had any difficulties sleeping due to your asthma symptoms (inc. cough and breathlessness)?
(2) Have you had your usual asthma symptoms (e.g. cough, wheeze, chest tightness or breathlessness) during the day?
(3) Has your asthma interfered with your usual daily activities (e.g. school, work, housework)?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

An unexpected condition many (40-60%) asthmatics have

A

Acid reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why treating acid reflux in asthma patients is beneficial

A

Improves spirometry (but not symptoms!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Conditions atopic individuals typically have aside from asthma

A

Eczema, hay fever, allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Allergens that commonly trigger asthma

A

House dust mites, pollen, fur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Percentage of asthma cases that are occupational

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Telling sign asthma may be occupational

A

Remission of symptoms during weekends or holidays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What to do if you suspect occupational asthma

A

Ask the patient to measure their peak flow at home and at work, at the same time intervals

17
Q

Signs

A
  • General overview: audible wheeze, cough
  • Arms: tachypnoea
  • Auscultation: reduced airy entry (decreased breath sounds), widespread polyphonic wheeze
  • Percussion: hyper-resonance
18
Q

Signs of a severe asthma attack

A
  • Inability to complete sentences
  • Pulse >110 bpm
  • RR >25/min
  • PEFR 33-50% predicted
19
Q

Signs of a life-threatening asthma attack

A
  • Silent chest
  • Confusion, exhaustion
  • Cyanosis
  • Low PaO2 (<8 kPa, i.e. rasp failure), but normal PaCO2 (4.7-6.0 kPa) - dangerous in this case!
  • Low O2 sats / SpO2 (<92%)
  • Bradycardia (<60 bpm)
  • PEFR <33% predicted
20
Q

Sign that indicates near fatal asthma and what should be done

A

A rising pCO2! Initially pCO2 is low due to hyperventilation. If it becomes normal or raised, this indicates failing respiratory effort and the patient needs ventilation!

21
Q

What to do if you suspect asthma in an adult

A

Perform spirometry or, if not available, peak flow

FEV1/FVC <0.7 –> high probability of asthma, >0.7 –> low probability

High probability of asthma –> trial of asthma treatment

  • If successful, continue minimum effective dose
  • If unsuccessful, assess inhaler technique/compliance –> if no further improvement consider onward referral

Low probability of asthma –> investigate/treat other cause
- If no response to treatment, consider further investigation or onward referral

22
Q

What to do if you suspect asthma in a child

A

Same as for adults, except don’t perform spirometry or PEFR

23
Q

Tests for chronic asthma

A
  • PEFR monitoring (diurnal variation of >20% on ≥3 days/week for 2 weeks)
  • Spirometry (decreased FEV1/FVC,
24
Q

(Diagnostic) tests for chronic asthma

A
  • PEFR monitoring (diurnal variation of >20% on ≥3 days/week for 2 weeks)
  • Spirometry (decreased FEV1/FVC, increased RV)
  • ≥15% improvement in FEV1 following a trial of B2 agonists or steroids
  • CXR (hyperinflation)
  • Skin-prick tests to help identify allergens
  • Histamine or methacholine challenge (airway hyper-reponsiveness is characteristic of asthma - patients with asthma only need very low doses of methacholine or histamine for a 20% fall in FEV1)
  • Aspergillus serology (why?)
25
Q

O2 sats of (1) are a serious sign (check ABGs!), except for individuals with what (2)?

A

(1) <92%

2) COPD (target SpO2: 88-92%

26
Q

O2 sats of (1) are a serious sign (check ABGs!), except for individuals with what (2)?

A

(1) <92%

2) COPD (target SpO2: 88-92%

27
Q

FEV1, FVC and FEV1/FVC ratio for

(1) normal airways
(2) obstructive lung disease
(3) restrictive lung disease

A

(1) FEV1 >80% predicted, FVC >80% predicted, FEV1/FVC 75-80% predicted
(2) FEV1 <80% predicted, FVC normal or low, FEV1/FVC <70% predicted
(3) FEV1 <80% predicted, FVC <80% predicted, FEV1/FVC >70% predicted

28
Q

FEV1, FVC and FEV1/FVC ratio for

(1) normal airways
(2) obstructive lung disease
(3) restrictive lung disease

A

(1) FEV1 >80% predicted, FVC >80% predicted, FEV1/FVC 75-80% predicted
(2) FEV1 <80% predicted, FVC normal or low, FEV1/FVC <70% predicted
(3) FEV1 <80% predicted, FVC <80% predicted, FEV1/FVC >70% predicted

29
Q

Some restrictive lung diseases

A

Fibrosis, pleural effusion (see Oxford Handbook)

30
Q

TLC and RV in

(1) obstructive lung disease
(2) restrictive lung disease

A

(1) Increased (hyperinflation)

(2) Reduced

31
Q

Differentials

A
  • Pulmonary oedema (‘cardiac asthma’, ?)
  • COPD (may co-exist)
  • Large airway obstruction (e.g. foreign body, tumour)
  • SVC obstruction (wheeze/dyspnoea not episodic, ?)
  • Pneumothorax
  • PE (chest pain)
  • Bronchiectasis (?)
  • Obliterative bronchiolitis (suspect in elderly, ?)
32
Q

Natural history

A
  • Most children with asthma grow out of it in adolescence or suffer much as less as adults, but not all
  • A significant number of people develop chronic asthma late in life (late-onset)
33
Q

Clinical features which increase probability of asthma in adults

A
  • Wheeze, SOB, chest tightness
  • Diurnal variation
  • Response to exercise, allergen, cold air
  • Symptoms after aspiring or beta-blocker
  • Personal history of atopy
  • Family history of atopy/asthma
  • Widespread wheeze on auscultation
  • Unexplained low FEV1 or PEFR
  • Unexplained blood eosinophilia
34
Q

Disturbed sleep is a sign of severe asthma. What is a sign of poorly controlled asthma in atopic individuals?

A

High levels of eosinophils in the blood

35
Q

Units for PEFR

A

L/min

36
Q

Factors that influence PEFR and spirometry

A

Age, gender, height

TCD (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions